chbare

What about a trach? Would an ET tube be the best choice if independent lung ventilation is needed? Unfortunately, it's not as simple as making the generalisation that the ETT is a gold standard.

I would not consider an endo-tracheal tube a "gold standard." Intubation carries it's own risks and complications. Also, intubation does not prevent aspiration. In fact VAP is a major problem and frequent oral care along with frequent oral suctioning and secretion management are often interventions included in VAP bundles.

Started in 1996. MAST/PASG was a well recognised intervention, the EOA/EGTA's were not uncommon, trauma patients received aggressive fluid resuscitation, supraglottic airways were frowned upon, the AED had not proliferated, Carbon-dioxide monitoring was not frequently used or even talked about, bretylium was still around, one of the first paramedic programmes in my state was conducted around 1998-1999 and consisted of just over 800 hours of total training.

A fundamental difference exists. Do those professions have a nationally recognised credentialling board mandate that their prospective practitioners take an official psychomotor examination where a representative of the said board runs the testing site? While many professions have similar exercises as part of their educational experience, typically before performing interventions on real patients, how many mandate such an exercise as a required part of the credentialling process?

Take an arbitrary definition and apply the current paradigm. By current paradigm I mean mandating all prospective providers complete the psychomotor skill exam. I cannot even compare it to other professions as none with the rare exception have anything like registry.

Is anybody aware of any evidence suggesting successful completion of the psychomotor exam correlates to a competent, entry-level paramedic. I am having a difficult time finding anything to support the current paradigm.

Congrats, I think.

Just remember, the hyperkalaemia is relative. DKA patients are typically hypokalaemic and it is common to add KCl to IV fluids in spite of an elevated serum Potassium. These patients typically loose large amounts of K+ due to dieresis and the elevated serum K+ is due to extra cellular shifts becsuse of acidosis. It's not uncommon to see dramatic reductions in serum K+ following fluid resuscitation and insulin when the pH begins to increase and the anion gap begins to close.

Solid post with sound reasoning and a reference to back your assertions up.

Around 1,000 mg/dl on a couple of people with pancreatitis and HHNKC.

If you are willing to sacrifice a bit for the sake of stimulating the economy, I highly recommend the MacBook Pro 15 inch retina. You'll need to fork out more to upgrade to a 512 GB SSD and a 2.6 GHz quad core ivy bridge and maybe extra RAM. However, you'll have a powerhouse with the most beautiful display I have ever seen. It's a gaming powerhouse as well. Games like Rage and Diablo III are beautiful and maintain consistent frame rates on high performance settings. If you really want to game, Mac now has popular games like Bioshock and Bioshock 2, COD Black Ops and Trine 2 on the App Store. Or, you can use boot camp to make a partition and install Windows.

I do not disagree; however, I would like to see evidence that a well rounded curriculum creates a better provider. Unfortunately, the evidence that I have seen in other fields is quite mixed. Even "landmark" studies involving higher educated nurses have significant flaws. I think we are going to have to produce evidence and essentially force people to change, but the evidence needs to exist. We are transitioning to an A&P and English class requirement for most EMS levels at our institution with a push toward degree only paramedic classes. Perhaps I will be able to to some sort of cohort comparison or look at certain other indicators in past classes with newer classes. Of course, that will likely take years.

Hope all turns out well.

Superinfections are huge and the problem is only getting worse.

Agreed, I just don't want people adding more into my motives or assuming I am up to something other than looking at an isolated piece of data and saying "huh, that's interesting." That would be interesting but I'm not sure it would be possible. I'm not really involved with that class and I cannot dig for too much information as that could encroach on student privacy. I would actually like to see if any related literature exists however.

I'm not requiring a class for anything. I simply made an anecdotal observation about two groups of students taking the same pathophysiology class. One group had in theory significantly more preparation in the form of an entire year of dedicated A&P taught by a dedicated A&P professor. Additionally, they all had microbiology, a year of English and chemistry. The other group only had the integrated A&P as stated. The results, anecdotal as they may be, challenged a common assertion. Upon researching, I've been unable to find strong evidence supporting said traditional assertions and now I'm putting it to the City. I appreciate the comments, but do not add anything else into this. I'm not making conclusions, changing policy or making mandates. I simply noticed something interesting and am having difficulty scratching the itch it has created. Just to be clear, this was a class that I did not teach and was not involved with it or the instructor.

I made it clear that I am not talking about the NREMT exam.

You will need paramedic credentials and often, many SWAT/SRT medics are also qualified officers. Your status as a veteran my be helpful for getting a foot in the door; however, you should not expect to go directly into a medic position with a SWAT/SRT team. Likely, you will have to put in time as an officer and make it into the team. Also remember, much of the medic's job revolves around tedious and less glamorous jobs such as keeping up on the team medical records and immunisations and developing medical SOP's and training. Overseas work is a different animal and will vary according to your job, the company and your location. In fact, I never did any cool guy shoot outs and didn't really carry a weapon when I was a contractor and I was outside of "the wire" quite often. My wife is a contractor currently and she's not doing the "I'm cooler than you" contractor gig either. Make sure you have realistic expectations of the job and regarding air support and such, as a private or civi contractor, Uncle Sam or any other Nation's military doesn't owe you anything.

To be clear, I am talking about a freshman level pathophysiology class.

The stand alone course is the typical year of anatomy and physiology that most every nursing and allied health student must complete. It is fairly comprehensive and includes a total of eight credits. Six of which are lecture and two are lab. The course typically occurrs over two semesters where the students do a three credit lecture and one credit lab per semester. Again, I cannot go into detail, but it at least makes me wonder if mandating a year of anatomy and physiology makes a quantitative difference. For example, would nurses and paramedics do better with stand alone A&P versus integrated A&P? I've yet to find smoking gun evidence to support my assertion that mandating a year of A&P makes students learn A&P better than an integrated course.

I recently had an experience that has at least led me to question a concept often touted on this site as essentially being an axiom. Unfortunately, I cannot go into details. Basically, it involved two groups of students taking the same phsiology based class. One group had completed a stand alone year long course in anatomy and physiology with labs while the other only had anatomy and physiology integrated into their training course. The pass rates of both groups were statistically insignificant. While not absolutely compelling it is leading me to at least consider long held beliefs. I assumed that one group would have performed significantly better, but that certainly was not the case. With that said, many factors were certainly uncontrolled and I am not presenting this as valid evidence, but rather an anecdote that goes against formal convention. I would ask for productive conversation regarding the topic at hand. You can be as specific or as broad as you want. Additionally, I would prefer to see literature on this issue as I have not found anything particularly compelling, one way or the other.

So, if my interpretation is correct: 1) I'm too busy. 2) I'm feeling clinically irrelevant. 3) I'm not liking the cyclic nature of the discussions here. I call BS on having to cut all your ties instead of simply pulling back your involvement, but you have got to do what you have to do. Good luck on the business as I know it's busy and growing.

On a serious note, the potential for a serious breakthrough in treating a deadly, drug resistant superinfection may exist. It's known as foecal transplantation and limited data indicates it may significantly impact our ability to treat [ C. diff ] super infections. It may be funny but the importance of this type of research cannot be over-emphasised.

I am not following the alcohol abuse and healthy heart correlation?

Thoughts go out to you and your family.